Deep End GP Pioneer scheme

Dr Petra Sambale, GP Lead

Keppoch Medical Practice, Possilpark, Glasgow

Deep End GP Pioneer Scheme

Dr David Blane, Academic Co-ordinator

Overview

• The Deep End Pioneer Scheme

• Impact of Scheme Year One and Two

• Post Scheme

Deep End Pioneer Scheme

• 5 Early career GP Fellows• 6 Deep End practices• 2 years

‘Key ingredients’:– Additional clinical capacity– Released time of experienced GPs for

service development– Protected time for Fellows for tailored

day-release curriculum and service development

– Shared learning across practices

Funded by…

GP Recruitment and Retention Fund

Shared Learning

• 6 to 8 weekly meetings with GPs and Fellows

• 2 meetings with Practice Managers

• Morning meeting

• Culture change to use protected time

• Peer support

Examples of Practice Projects

Access

Prescribing

Screening

Anticipatory Care

Osteoporosis

Migrant

Health

Vulnerable

Families

DiabetesGP Systems

Frequent

Attenders

Engaging Others

Community Resources

Complex patients

3 sessions /wk for each practice

Examples of Practice Projects

• Transition of General Practice Partnerships

• Able to recruit

Sharing of learning

IT platform: Trello

Also sharing within and between clusters

Day-release curriculum

• External speaker (approx. half have been Deep End GPs; half from other services/backgrounds)

• Fellows take turns to write up• Also time for:

• Reflective writing• Small group learning• Discussing practice projects/issues• Engagement activities

• REACH• Medical student conference• Regional Trainers’ conference

• Examples:• Child protection• Living with poverty• Palliative care• Complex trauma• Violence reduction unit• Chronic pain

Impact of the Pioneer Scheme

• Year One Report: Fellows

– More supported compared to locums

– Part of the team (well established teams)

– Regular employment / CPD needs met

– Time to undertake projects

– Deep End experience / leadership roles

Impact of the Pioneer Scheme

• Year One Report: GPs– Less stressed and burnt out GPs / retention

– Extended appointment time

– Time for ACP / visits / case management

– Quality improvement positive impact on patient care

– Wider engagement: students/studies/projects

Impact of the Pioneer Scheme

• Year One Report: Practices

– Increased morale

– Increased job satisfaction

– Team meetings

– Time

Year 2 Learning

• Consolidation of new work patterns

• Group coherence

• Mismatch Fellow/Practice

• Admin support

• Lack of evaluation

• Unclear future

Jan 19 Practice Feedback

• Lack of reflection/project time missed

• Lack of extra capacity felt

• Unable to recruit for a retiring partner with impact on remaining partners

• Longer waiting times for routine appts/more work in own time

• One development session per month

• Transition to GP partner smoother

Jan 19 Practice Feedback

• Practices are identifying clinical areas e.g. NPT that need updating but lack of time

• Continue some of the implementations

• Uncertain about future

• “Tough”, holiday cover

• Reduction of sessions

• “I cannot do this forever”

• Admin staff are missing GP time

Jan 19 Fellows

• Regular use of shared resources

• Peer support

• Highlight: meaningful shared learning between practices

• Fellow: Teaching programme/Partner: protected time

• Continue locum work in Deep End practices

• How to spot a good practice

• Excellent scheme/continuity with patients and support

• Difference in workload since leaving scheme

Jan 19 Fellows

• Days much busier, no catch up time with academic sessions despite admin time

• Increased stress, lack of time

• “It frustrates me that GPs trying to do good work and make positive changes are expected to do this in their own time”

Own observations/Summary

• Observations: competent, compassionate, caring, community orientated practices, avoidance of duplication, clinical innovators

• R&R, collaborative working/~10% extra capacity, but net gain?

• Fellow experience positve

• New GP contract / lack of funding increase for deprived practices

• Burnout/recruitment/retention of “C” GPs /practices

Thank you for listening….Any questions?

psambale@nhs.net

deependgp@gmail.com

@deependgp